The rectum is the last part of the digestive tract, which can be divided into upper, middle and lower thirds. It is this section of the bowel and the coordinated action of the sphincter muscles that allow for voluntary defecation and the holding of stool (continentia). Malignant tumours of the rectum and anus may require complete removal. A laparoscopic abdominoperineal rectal extirpation involves the complete removal of the rectum, with removal of the sphincter around the rectum and the anus and formation of a stoma with a sigmoid colon in the end position. During the abdominal phase of laparoscopic surgery, 3-4 incisions of 5-10 mm are made, where the camera is inserted and additional instruments are used to remove the rectum and form the stoma. In the gastrocaval section, a circular incision is made around the anus to remove it.
In advanced cases, malignant lesions can lead to intestinal obstruction, bleeding, peritonitis through perforation of the intestinal wall, metastases to distant organs, and complications can ultimately lead to death.
You will most likely arrive the day before your operation. However, we will carry out the necessary tests 1-2 weeks before the planned day of surgery, which may include laboratory tests, ECG, X-ray and anaesthesia if necessary.
Colonoscopies may require complete emptying of the colon and rectum, and your surgeon may ask you to follow a fluid diet for a few days before the operation, and you may also need to take a stool softener or enema before the operation. Your surgeon will give you detailed advice on this.
The operation is performed under general anaesthesia. Through a small incision made above the navel, the abdominal cavity is inflated with carbon dioxide gas through a special device. The laparoscope is a thin tube with a camera at the end, which is used to navigate inside the abdomen, to view the abdomen, and to follow the operation on a large screen. 3-4 small incisions are made, through which the instruments are inserted and the rectum, including the fat tissue around the rectum (mesorectum), the potentially affected lymph nodes and lymphatic vessels, and the sphincter around the rectum are removed.
The sigmoid colon stump is converted into a terminal stoma. If the surgical situation so requires, silicone tubes (drains) are temporarily left in the abdominal cavity or the peritoneal region to drain any blood clots or bleeding.
Sometimes the lesion cannot be safely removed using laparoscopic techniques, in which case we will switch to open abdominal surgery. Following surgery, the stool is emptied into a stoma bag that can be fixed to the abdominal wall. It is not possible to close the stoma after the procedure.
The advantages of laparoscopic surgery over open surgery:
There is no alternative therapy for malignant lesions of the rectum. In some cases, so-called neoadjuvant treatment (radiotherapy, chemotherapy) may be necessary to reduce the size of the tumour tissue to help the surgery succeed.
After waking up, you can expect to feel discomfort, and we will do our best to minimise this, or if it has developed, to alleviate it.
There may also be discomfort around incisions, which should also improve considerably with the use of painkillers. Following surgery, incisions are anaesthetised with a local anaesthetic, which minimises wound pain.
You usually need to stay in our institution for 3-5 days.
As with all laparoscopic operations, a conversion to open surgery may be necessary for abdominoperineal rectal extirpation.
Possible complications of the procedure:
Bleeding, abdominal haematoma, infection of the wound, fistula formation, skin of the abdomen around the scar may become numb (usually resolves within 2-3 months), deep vein thrombosis
The operation involves the insertion of an intravenous cannula, a bladder catheter and a gastric tube, which is passed through the nose and is used to drain the intestinal fluid that builds up in the upper intestinal tract and reduce the possibility of nausea. These devices are expected to be removed within 1-3 days after surgery.
Recovery time after surgery for cancer depends on the size and histological characteristics of the tumour.
When can I take a bath or shower?
There will be a clean covering dressing in the wound, which will be changed periodically by appointment. You can safely wash the rest of the body, but keep the dressings completely dry for the first 48 hours. Avoid bathing or swimming until the stitches are removed, soaking the wound increases the likelihood of infection.
Exercise:
You will feel more fatigued in the few weeks after surgery, a gradual return to daily activity is recommended. For the first 6-8 weeks, avoid heavy physical work, lifting weights and intense sports activities.
Work:
Return to work depends on the type of work and the extent of the surgery. You can expect to return to work within 2-3 weeks if you have laparoscopic surgery.
